Edenhurst Rest Home

People’s experience of using this service:

People were not always protected from the risk of an acquired health infection, as the service did not provide adequate handwashing facilities in all rooms. Staff did not always ensure the environment was clean. Although appropriate policies and procedures to monitor and reduce the risk of infection were in place these were not always followed

Systems were in place to support people to take their medicines safely, but these were not always followed. Staff did not always record and manage medicines prescribed ‘as required’ safely. Information recorded about people’s allergies to medicines was contradictory.

Safe recruitment practices were in place but not always evidenced. Information regarding proof of identification and DBS checks was not present for all staff.

People felt safe and staff ensured that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people’s needs. Staff had received training to ensure they had the knowledge to protect people from the risk of avoidable harm or abuse, whilst providing care.

Staff received relevant training and felt well supported. People were asked for their consent to their care and appropriate steps were taken to support people who lacked capacity to make decisions.

People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people using the service and the staff who cared for them. Staff promoted people's right to make their own decisions about their care where possible and respected the choices they made. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required.

People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff.

There were quality monitoring procedures in place but these were not always effective at identifying and responding to issues.

The management structure of the service was clear.

People's safety had been considered and risks had been reduced by the introduction of equipment or guidance. Staff had received training in relation to safeguarding and knew how to protect people from harm.

Information was provided in a range of formats to support understanding. People were able to access spiritual support to meet their religious beliefs.

There was a registered manager at the home and the rating from their previous inspection was displayed at the home and on their website. When required notifications were usually completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

Rating at last inspection: Requires Improvement (Published January 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found the service had improved in some areas but remained Requires improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

two people to share. On the days of our inspection 22 people were living at the home, all of these were older people, some of whom were living with dementia.

We carried out an unannounced comprehensive inspection of this service on 10 and 18 January 2018. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. The team inspected the service against two of the five questions we ask about services: is the service safe and is it well led. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

At the inspection in January 2018 we found people were not always adequately protected from risks associated with their care and support such as falls, or pressure ulcers. There were no formal systems in place to learn from accidents and incidents. People were not consistently protected from risks associated with the environment. Risks associated with areas such as the stairs and windows had not been adequately assessed or managed and this placed people at risk of harm. The environment and equipment used in people's care and support was not always clean. Medicines were not always stored safely, this increased the risk of error.

People were not protected from improper treatment or abuse, as action was not taken to conduct thorough and robust investigations, or to refer to the local authority safeguarding adult’s team as required.

There was a lack of formal audit and quality assurance systems and those in place were not effective. This meant risks to people's health and safety were not always identified or addressed.

Following our inspection we issued warning notices to the service against regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to provide us with an action plan to show what they would do and by when to improve the key questions Well Led and Good to at least good.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager who was also the provider had employed a home manager and both were available during our inspection.

At this inspection we found the provider had made the necessary improvements to ensure they were no longer in breach of the three regulations.

People were protected against the risk of abuse as the provider had processes in place to ensure any safeguarding issues were escalated and investigated appropriately. Staff had the necessary knowledge to identify any issues of concern and were aware of their roles and responsibilities in relation to keeping people safe.

The risks to people’s personal safety had been appropriately assessed and measures put in place to mitigate those risks. There was regular monitoring and assessment of risks of the environment people lived in. We saw significant progress had been made to reduce risks to people at the service.

There was effective quality monitoring processes in place to highlight any shortfalls in practice and the necessary actions to improve the quality of the service had been taken.

We carried out our first inspection visit in November 2017. During the course of our inspection we received concerns in relation to the quality and safety of the home. As a result we returned to the service in January 2018 to look into those concerns.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found the service was not safe. People were not always adequately protected from risks associated with their care and support such as falls, or pressure ulcers. There were no formal systems in place to learn from accidents and incidents. People were not protected from improper treatment or abuse, as action was not taken to conduct thorough and robust investigations, or to refer to the local authority safeguarding adults team as required. People were not consistently protected from risks associated with the environment, risks associated with areas such as the stairs and windows had not been adequately assessed or managed and this placed people at risk of harm. The environment and equipment used in people’s care and support was not always clean.

Medicines were not always stored safely this increased the risk of error. However, people received their medicines as required. There were not always enough staff available to ensure people’s safety. Safe recruitment practices were not always followed.

Where people lacked capacity to make choices and decisions, their rights under the Mental Capacity Act (2005) were not always respected. Some people had restrictions imposed upon their rights but we could not be assured this was in their best interests. People who had the capacity to make decisions were supported to have choice and control of their lives. Staff did not receive sufficient training to enable them to effectively meet people’s individual needs. Staff were provided with regular supervision and support.

People’s day to day health needs were met and they were supported to access healthcare as required. Where people had specific health conditions more information was needed in care plans to ensure they got the support they needed. The physical environment had been adapted to meet people’s needs, further work was required to ensure people’s needs associated with dementia were met by the design and decoration of the home. People had enough to eat and drink and were provided with choices and assistance as needed.

People were supported by staff who were kind and compassionate and treated them with respect. People’s rights to privacy and dignity were respected. Staff understood how people communicated and people were provided with information in a way that was accessible to them. People were enabled to have control over their lives and were supported to be as independent as possible.

People were at risk of receiving inconsistent support as care plans did not provide an accurate or up to date description of their needs. People and their families were not consistently offered opportunity to be involved in planning their care and support. People knew how to raise issues and complaints, and were confident action would be taken to address any concerns raised. People were given opportunities to get involved in meaningful social activity within the home and the local community.

There was a lack of formal audit and quality assurance systems and those in place were not effective. This meant risks to people’s health and safety were not always identified or addressed. Timely action was not always taken in response to known issues. Accurate and up to date records were not kept of people’s care and support. The provider had not kept up to date with current guidance and legislation. People who used the service, staff and visiting health professionals were positive about the home and had some opportunities to share feedback about the quality of the service provided at the home.

During this inspection we found multiple breaches of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were systems in place to protect people from abuse or the risk of abuse. Staff knew the lines of reporting in the organisation and people we spoke with felt safe in the home.

We found that staff were supported to receive appropriate professional development. People we spoke with gave positive feedback about the staff and how they cared for them. They said things like, 'The staff are very helpful. You only have to ask and they do it', 'Nothing is too much trouble for the staff' and 'They know me well here. I can't fault them.'

None of the people we spoke with had any concerns about the service. One person said, 'I have no concerns at all, everything is wonderful.'

We received many positive comments from people about the care they received in the home. Comments included, 'I feel very fortunate to be here. I would recommend it to anyone', 'I am very happy here, staff care for me the way I like', 'You get good care here. I wouldn't want to be anywhere else' and 'I am well cared for and the staff are lovely.'

People we spoke with told us they felt safe in the home and felt they could speak with staff or the manager if needed to. One person using the service told us, 'I feel safe here. If I was worried about anything I would talk to the person in charge.'

People spoken with gave positive feedback about the care staff were delivering. They said things like, 'The staff are all lovely, I think they are very good', 'I can't fault them. They work hard to make us happy here.'

Records were kept securely and could be located promptly when needed. We saw care plans and other care records were held securely in a cupboard. Staff were able to access these when needed.